MEDICARE: WESAM MOHAMMADSAID ALTAMIMI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	49446	CA

General Provider Information

NPI Number	:	1649496290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESAM MOHAMMADSAID ALTAMIMI DDS

Provider Business Mailing Address
First Line	:	5353 BALTIMORE DR
Second Line	:	APT# 66
City	:	LA MESA
State	:	CA
Zip	:	91942-4607
Country	:	US
Telephone Number	:	559-313-7511
Fax Number	:

Provider Business Practice Location Address
First Line	:	3802 CLAIREMONT MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2712
Country	:	US
Telephone Number	:	858-273-8300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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